Mr Narendra Modi, TB control holds the key to progress in India

I have heard a lot of good things about you. I have also heard that you are proactive and want progress for India. And that you have good advisors around you. Then, pray why have they not told you that India carries the highest burden of TB in the world? Did they think it is not important, or did they tell you that it’s not a big deal; TB is a disease just like any other? Did they also reassure you that we have a great TB programme which has been lauded as good over the world and that that alone is enough for us to eradicate TB? Did they also tell you that TB affects only the poor and the poor don’t matter as they cannot affect our progress and productivity?

I’m sure you don’t have the time to verify the correctness of these facts for yourself. I understand. But I am hoping this post will somehow reach you. I am told that you heed good advice, and I’m hoping you consider this good advice. Ambitious huh? But then, my people, your people deserve it, so here is my feeble attempt.

Contrary to what people told you Mr Modi, TB is not, by definition, a poor man’s disease. TB is an airborne, droplet infection. Technically anyone who breathes in the bacteria can get it. But TB does not infect everyone who inhales the bacteria. It affects the poor more severely because so much else is missing from their lives. It affects the immune-compromised. And those who do not have access to affordable primary health care, good housing, nutrition and healthy living and working conditions become immune-compromised. These are all very basic requirements I know, but the truth is they lack it. The inference therefore, and correctly so, is that TB is a reflection of social and economic conditions of a country or society. It is less about providing medication (important as that is for people who already have the disease), and more about providing the environment where TB cannot play havoc with lives.

Did anyone tell you that TB is preventable, if the powers-that-be want to prevent it? But the prevention is not the kind that comes from vaccinations. History from developed nations has proved that improving living conditions has gradually driven TB away, because the contributing factors go away, people become healthier, their immune systems improve and they are not vulnerable to TB anymore. Incidences have reduced and some countries are close to eradicating it. Do you know for instance that Cuba, a small country in comparison with India, and a country that has traditionally faced blockades and isolation owing to its allegiance to the erstwhile USSR, has managed to bring down TB incidence to 6/1,00,000? How did they do it, and how did they do it in the face of such isolation and hardships? It is because they accorded health the highest priority in the development agenda. And they systematically improved living conditions for the people.

A paper entitled No one left abandoned”: Cuba’s national health system since the 1959 revolutionby Dr Pol De Vos, Department of Public Health, Institute for Tropical Medicine, Antwerp, Belgium, points out, “In spite of the economic hardships during the 1990s, Cuba has achieved health indicators that are among the best in the world. Today, health care continues to be of high quality and free for all Cubans. It remains exclusively in the hands of the public sector, and privatization is not an option. This is exactly the opposite of what is happening in other parts of the world where public services are underfunded and people are made to believe that privatization is the only way to ensure high-quality care.”

No Mr Prime Minister, please don’t tell me that Cuba is a small country and hence things are easier for them. Big or small, things are never easy. In the face of great hardships, they found the money to improve the lives of their people. But we, in India, are currently facing cuts in health care budgets and cuts in budgets of other social welfare schemes. I am an ignorant person. Can you tell me Mr Prime Minister, how, in a country so full of illiterate and unskilled people, we can cope if social security schemes are suddenly curtailed? How can you abandon these people and expect them to do well?

As a final message I want to tell you Mr Prime Minister that TB actually holds a mirror to society. And it is currently reflecting a very ugly image of India. Do we have data on how many in India are victims of poor living and working conditions. We don’t, but common sense and anecdotal evidence tells us that the number is huge. It’s a question of whether the egg or the chicken came first. If you don’t improve living conditions, TB won’t go away; if TB doesn’t go away, you’ll have a sick and weak population who can’t anyway work to bring progress to India. Do you have a choice? And do you have a choice other than to improve the whole of India? You have just rolled our some very evocative programmes, Swacch Bharath, Beti Bachao, etc, etc. Please get your advisers to mainstream TB into all of them and to also analyse the linkages. Where do they all converge? Do they look at equity? Do the benefits accrue to all in India equally, regardless of caste and creed? If yes, we are in the right direction. If no, kindly do a rethink; there is still time, but not much. The world is hurtling forward and we can’t be left behind. I am not talking of the few who will anyway surge forward with you. I am talking of the multitudes like me, and those who are less fortunate than me. So please choose your priorities; our lives and fate lie in your hands.

Why did I not address this to the Health Secretary or Health Minister? Why you? Because Mr Modi, this needs intervetion from the highest levels and you are that highest level today. We deserve this Mr Modi, give it to us.

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[…] India has had more than a few “I told you so!” moments at the 47th Union World Conference on Lung Health. For years now, the TB sector in India has been cautioning the government on the dangers of neglecting, or providing inadequate support, or even ignoring implementation gaps in TB control in India. The Government of India, much in the way of an impetuous, headstrong teenager, has ignored all these warnings. It has sat back complacently, happy it has a TB control programme in place and the budgets for it, regardless of how it is working on the ground. And today, on the world stage, it’s all in the open. The gaps are rearing their ugly heads for the world to see. The figures are not important; they are oft quoted. But they are also not healthy. The recently released Global TB Report 2016 strengthens the argument. […]